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IRRADIANCE MEDICAL GROUP INC NPI 1740213198


NPI Information

NPI: 1740213198
Provider Name: IRRADIANCE MEDICAL GROUP INC
Classification: Dermatology - 207NS0135X
Entity Type: Organization

Specialization: Procedural Dermatology

CLIA Number: 05D0934437

Address:
420 E 3RD ST STE 805
LOS ANGELES, CA
ZIP 90013
Phone: (213) 687-3214
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IRRADIANCE MEDICAL GROUP INC is a procedural dermatology dermatology in Los Angeles, CA. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). IRRADIANCE MEDICAL GROUP INC NPI is 1740213198. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

420 E 3RD ST STE 805
LOS ANGELES, CA
ZIP 90013-646
Phone: (213) 687-3214
Fax: (213) 687-0622

The provider's authorized official is Christopher Tsung Lung Ho .
The authorized official title is Owner and has the following contact phone number (213) 687-3214.

The CLIA number assigned to this NPI record is 05D0934437 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 9/1/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207NS0135XDermatologyProcedural DermatologyA55242CALIFORNIANo
2207NS0135XDermatologyProcedural DermatologyG77152CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1G42567MEDICARE UPINCALIFORNIA
2F87356MEDICARE UPINCALIFORNIA
300G771521MEDICAIDCALIFORNIA
4W15456MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAGROUP NUMBER
5WG77152CMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
6WA55242CMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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